This invention relates to the healthcare industry, specifically the relationship between physicians (MDs), managed care organizations (MCOs), pharmacy benefit management companies (PBMs), pharmaceutical companies, and patients. MDs treat patients using prescription drugs that are manufactured by pharmaceutical companies. MCOs seek to evaluate and select prescription drugs for particular treatments based upon both healthcare and commercial perspectives, and the MCOs recommend and approve selected prescription drugs for coverage under a managed care contract using what can be referred to as a formulary.
Medical doctors today deal with an average of 5 to 6 MCO (or PBM) plans to which their patients subscribe. When the number of benefits plans is multiplied by the number of possible disease conditions of their patients, the number of formularies that the MDs have to deal with becomes overwhelming. For example, if an MD works with six MCO plans and there are ten disease conditions that they treat, then there may be sixty (60) formularies that they have to remember or be able to refer to prior to selecting a drug for a particular treatment. Accordingly, for each patient that visits a particular MD for treatment for the first time, the MD is likely to identify the patient's MCO and/or PBM plan. Then, for the particular disease state or condition being treated, the MD may have to recollect or research the formulary for the particular MCO and/or PBM before selecting a treatment.
Consequently, medical doctors may prescribe drugs that they remember as being approved, drugs they are most comfortable with, or drugs they consider as standard therapy for the particular disease state. Oftentimes this results in the doctor selecting a drug that is inconsistent with the formulary of the MCO and/or PBM (i.e., the drug that they have prescribed is not the most preferred or, in the worst case, the drug is not even approved by the MCO and/or PBM).
This lack of what is called “formulary compliance” creates many problems in the industry. MCOs and PBMs lose revenue and the patients may also incur an increase in out of pocket expense. The health benefits to the patient may also be reduced. Additionally, the MCOs and PBMs have increased costs in trying to correct the problem immediately at the pharmacy, or in the future with the errant medical doctor through letters and phone calls. The medical doctors also have increased expenses because their staff has to handle the subsequent communications from the providers (MCOs and PBMs) and the pharmacies.
Accordingly, there is a need in the industry for improved formulary compliance.